Critical illness as a result of anti-neoplastic therapy

Robert Greiner, Kevin M. Mulieri, Robert Tamburro, Raymond Barfield

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Although cancer is responsible for more deaths in children over 1 year of age than any other disease, outcomes are improving as a result of many factors including better supportive care and increasingly aggressive anti-neoplastic regimens. As a result, the pediatric intensivist will likely encounter many complex clinical challenges related to the therapy for childhood cancer. Chemotherapy can, in the course of reducing tumor burden, also bring about life-threatening changes in organ function, metabolism and electrolyte levels. The destruction of tumor cells results in the release of intra-cellular contents in tumor lysis syndrome, and this may lead to a range of problems including cardiac arrhythmias, tetany and renal failure. In addition, the chemotherapy may produce life-threatening toxicity to otherwise healthy tissues. An understanding of these toxicities enables the intensive care physician to anticipate problems and intervene in a timely manner. Radiation therapy can also lead to a wide variety of organ dysfunction, most notably, lung injury. Radiation pneumonitis presents a true diagnostic challenge requiring a clear understanding of both the use and timing of anti-neoplastic therapy in conjunction with an appreciation for the clinical and radiographic findings suggestive of this disorder. Additionally, the impact of anti-neoplastic therapy on the immune system has been well established. Neutropenic enterocolitis (typhlitis) is an acute, potentially life-threatening, necrotizing inflammation of the cecum and colon reported to occur in children treated for leukemia as well as other malignancies. Furthermore, the myelosuppression associated with many forms of anti-cancer therapy predisposes the child with cancer to bacteremia and sepsis. Encouragingly, with timely critical care interventions, the outcomes from severe sepsis in non-transplant oncology patients now approximate those of the general pediatric population. In sum, therapy for cancer in children can profoundly impact physiology and the pediatric intensivist must have a sound working knowledge of these effects.

Original languageEnglish (US)
Title of host publicationGastroenterological, Endocrine, Renal, Hematologic, Oncologic and Immune Systems
PublisherSpringer-Verlag London Ltd
Pages363-383
Number of pages21
Volume3
ISBN (Electronic)9781447164166
ISBN (Print)1447164156, 9781447164159
DOIs
StatePublished - Feb 1 2014

Fingerprint

Critical Illness
Neoplasms
Pediatrics
Therapeutics
Neutropenic Enterocolitis
Sepsis
Typhlitis
Tumor Lysis Syndrome
Radiation Pneumonitis
Tetany
Drug Therapy
Cecum
Lung Injury
Critical Care
Bacteremia
Tumor Burden
Electrolytes
Renal Insufficiency
Cardiac Arrhythmias
Immune System

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Greiner, R., Mulieri, K. M., Tamburro, R., & Barfield, R. (2014). Critical illness as a result of anti-neoplastic therapy. In Gastroenterological, Endocrine, Renal, Hematologic, Oncologic and Immune Systems (Vol. 3, pp. 363-383). Springer-Verlag London Ltd. https://doi.org/10.1007/978-1-4471-6416-6_25
Greiner, Robert ; Mulieri, Kevin M. ; Tamburro, Robert ; Barfield, Raymond. / Critical illness as a result of anti-neoplastic therapy. Gastroenterological, Endocrine, Renal, Hematologic, Oncologic and Immune Systems. Vol. 3 Springer-Verlag London Ltd, 2014. pp. 363-383
@inbook{38f936051bf140fe9d58959834df5cc0,
title = "Critical illness as a result of anti-neoplastic therapy",
abstract = "Although cancer is responsible for more deaths in children over 1 year of age than any other disease, outcomes are improving as a result of many factors including better supportive care and increasingly aggressive anti-neoplastic regimens. As a result, the pediatric intensivist will likely encounter many complex clinical challenges related to the therapy for childhood cancer. Chemotherapy can, in the course of reducing tumor burden, also bring about life-threatening changes in organ function, metabolism and electrolyte levels. The destruction of tumor cells results in the release of intra-cellular contents in tumor lysis syndrome, and this may lead to a range of problems including cardiac arrhythmias, tetany and renal failure. In addition, the chemotherapy may produce life-threatening toxicity to otherwise healthy tissues. An understanding of these toxicities enables the intensive care physician to anticipate problems and intervene in a timely manner. Radiation therapy can also lead to a wide variety of organ dysfunction, most notably, lung injury. Radiation pneumonitis presents a true diagnostic challenge requiring a clear understanding of both the use and timing of anti-neoplastic therapy in conjunction with an appreciation for the clinical and radiographic findings suggestive of this disorder. Additionally, the impact of anti-neoplastic therapy on the immune system has been well established. Neutropenic enterocolitis (typhlitis) is an acute, potentially life-threatening, necrotizing inflammation of the cecum and colon reported to occur in children treated for leukemia as well as other malignancies. Furthermore, the myelosuppression associated with many forms of anti-cancer therapy predisposes the child with cancer to bacteremia and sepsis. Encouragingly, with timely critical care interventions, the outcomes from severe sepsis in non-transplant oncology patients now approximate those of the general pediatric population. In sum, therapy for cancer in children can profoundly impact physiology and the pediatric intensivist must have a sound working knowledge of these effects.",
author = "Robert Greiner and Mulieri, {Kevin M.} and Robert Tamburro and Raymond Barfield",
year = "2014",
month = "2",
day = "1",
doi = "10.1007/978-1-4471-6416-6_25",
language = "English (US)",
isbn = "1447164156",
volume = "3",
pages = "363--383",
booktitle = "Gastroenterological, Endocrine, Renal, Hematologic, Oncologic and Immune Systems",
publisher = "Springer-Verlag London Ltd",

}

Greiner, R, Mulieri, KM, Tamburro, R & Barfield, R 2014, Critical illness as a result of anti-neoplastic therapy. in Gastroenterological, Endocrine, Renal, Hematologic, Oncologic and Immune Systems. vol. 3, Springer-Verlag London Ltd, pp. 363-383. https://doi.org/10.1007/978-1-4471-6416-6_25

Critical illness as a result of anti-neoplastic therapy. / Greiner, Robert; Mulieri, Kevin M.; Tamburro, Robert; Barfield, Raymond.

Gastroenterological, Endocrine, Renal, Hematologic, Oncologic and Immune Systems. Vol. 3 Springer-Verlag London Ltd, 2014. p. 363-383.

Research output: Chapter in Book/Report/Conference proceedingChapter

TY - CHAP

T1 - Critical illness as a result of anti-neoplastic therapy

AU - Greiner, Robert

AU - Mulieri, Kevin M.

AU - Tamburro, Robert

AU - Barfield, Raymond

PY - 2014/2/1

Y1 - 2014/2/1

N2 - Although cancer is responsible for more deaths in children over 1 year of age than any other disease, outcomes are improving as a result of many factors including better supportive care and increasingly aggressive anti-neoplastic regimens. As a result, the pediatric intensivist will likely encounter many complex clinical challenges related to the therapy for childhood cancer. Chemotherapy can, in the course of reducing tumor burden, also bring about life-threatening changes in organ function, metabolism and electrolyte levels. The destruction of tumor cells results in the release of intra-cellular contents in tumor lysis syndrome, and this may lead to a range of problems including cardiac arrhythmias, tetany and renal failure. In addition, the chemotherapy may produce life-threatening toxicity to otherwise healthy tissues. An understanding of these toxicities enables the intensive care physician to anticipate problems and intervene in a timely manner. Radiation therapy can also lead to a wide variety of organ dysfunction, most notably, lung injury. Radiation pneumonitis presents a true diagnostic challenge requiring a clear understanding of both the use and timing of anti-neoplastic therapy in conjunction with an appreciation for the clinical and radiographic findings suggestive of this disorder. Additionally, the impact of anti-neoplastic therapy on the immune system has been well established. Neutropenic enterocolitis (typhlitis) is an acute, potentially life-threatening, necrotizing inflammation of the cecum and colon reported to occur in children treated for leukemia as well as other malignancies. Furthermore, the myelosuppression associated with many forms of anti-cancer therapy predisposes the child with cancer to bacteremia and sepsis. Encouragingly, with timely critical care interventions, the outcomes from severe sepsis in non-transplant oncology patients now approximate those of the general pediatric population. In sum, therapy for cancer in children can profoundly impact physiology and the pediatric intensivist must have a sound working knowledge of these effects.

AB - Although cancer is responsible for more deaths in children over 1 year of age than any other disease, outcomes are improving as a result of many factors including better supportive care and increasingly aggressive anti-neoplastic regimens. As a result, the pediatric intensivist will likely encounter many complex clinical challenges related to the therapy for childhood cancer. Chemotherapy can, in the course of reducing tumor burden, also bring about life-threatening changes in organ function, metabolism and electrolyte levels. The destruction of tumor cells results in the release of intra-cellular contents in tumor lysis syndrome, and this may lead to a range of problems including cardiac arrhythmias, tetany and renal failure. In addition, the chemotherapy may produce life-threatening toxicity to otherwise healthy tissues. An understanding of these toxicities enables the intensive care physician to anticipate problems and intervene in a timely manner. Radiation therapy can also lead to a wide variety of organ dysfunction, most notably, lung injury. Radiation pneumonitis presents a true diagnostic challenge requiring a clear understanding of both the use and timing of anti-neoplastic therapy in conjunction with an appreciation for the clinical and radiographic findings suggestive of this disorder. Additionally, the impact of anti-neoplastic therapy on the immune system has been well established. Neutropenic enterocolitis (typhlitis) is an acute, potentially life-threatening, necrotizing inflammation of the cecum and colon reported to occur in children treated for leukemia as well as other malignancies. Furthermore, the myelosuppression associated with many forms of anti-cancer therapy predisposes the child with cancer to bacteremia and sepsis. Encouragingly, with timely critical care interventions, the outcomes from severe sepsis in non-transplant oncology patients now approximate those of the general pediatric population. In sum, therapy for cancer in children can profoundly impact physiology and the pediatric intensivist must have a sound working knowledge of these effects.

UR - http://www.scopus.com/inward/record.url?scp=84929130425&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84929130425&partnerID=8YFLogxK

U2 - 10.1007/978-1-4471-6416-6_25

DO - 10.1007/978-1-4471-6416-6_25

M3 - Chapter

SN - 1447164156

SN - 9781447164159

VL - 3

SP - 363

EP - 383

BT - Gastroenterological, Endocrine, Renal, Hematologic, Oncologic and Immune Systems

PB - Springer-Verlag London Ltd

ER -

Greiner R, Mulieri KM, Tamburro R, Barfield R. Critical illness as a result of anti-neoplastic therapy. In Gastroenterological, Endocrine, Renal, Hematologic, Oncologic and Immune Systems. Vol. 3. Springer-Verlag London Ltd. 2014. p. 363-383 https://doi.org/10.1007/978-1-4471-6416-6_25